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Query: UMLS:C0033774 (pruritus)
 14,546 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Uremic pruritus and its treatment are reviewed. Pruritus affects 50-90% of patients undergoing peritoneal dialysis or hemodialysis; symptoms usually begin about six months after the start of dialysis and range from localized and mild to generalized and severe. The mechanism underlying uremic pruritus is poorly understood; possibilities include secondary hyperparathyroidism and divalent-ion abnormalities; histamine, allergic sensitization, and proliferation of skin mast cells; hypervitaminosis A; iron-deficiency anemia; neuropathy and neurologic changes; or some combination of these. The cornerstone of therapy for uremic pruritus is regular, intensive, efficient dialysis. Other nonpharmacologic measures consist of the use of non-complement-activating dialysis membranes, compliance with dietary restrictions, electric-needle (acupuncture) therapy, and ultraviolet light therapy. Pharmacologic treatments that have been used include activated charcoal, antihistamines, capsaicin, cholestyramine, emollients and topical corticosteroids, epoetin, pizotyline, ketotifen, and nicergoline. Treatment results have been highly variable, and many of the clinical trials have been flawed. Phosphate-binding agents appear to be the most effective. Although enough is known to determine a reasonable set of steps in approaching a patient's uremic pruritus, more research is needed to understand the pathophysiology of this condition and to establish more reliable treatments. Pruritus is a common and sometimes severe complication of chronic renal failure. Efficient dialysis, dietary restrictions, phosphate-binding therapy, and phototherapy are the most effective treatments currently available.
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PMID:Uremic pruritus. 887 22

The case of a 36-year-old man with a villous adenoma of the duodenum is presented. His history included jaundice, pruritus, and weight loss. Physical examination was otherwise unremarkable. Laboratory data included anemia, guaiac-positive stool, hyperamylasemia, and abnormal liver function tests. Biliary ductile dilation was seen on ultrasonography; a filling defect in the duodenum was seen on CT scan, and endoscopic biopsy revealed villous adenoma with dysplasia. Pancreatoduodenectomy was performed and recovery was uneventful. Histopathology confirmed moderate dysplasia. Review of the literature reveals this to be a rare lesion (less than 1% of duodenal neoplasms). Local excision has been advocated for small, histologically proven benign, lesions. Where doubt of benignity exists, however, and in the case of "giant" tumors (>3.0 cm greatest dimension), pancreatoduodenectomy is indicated.
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PMID:Pancreatoduodenectomy for giant benign villous adenoma of the ampulla of Vater. 912 23

An assessment of gynecological morbidity among 385 married mothers of children 6-12 months of age from a district in South India's Karnataka State revealed a high burden of reproductive tract infections. Research methods included clinical examination, laboratory tests, and self-reports. A total of 152 women reported 226 gynecological complaints to a social worker, primarily vaginal discharge with bad odor and itching or irritation (22%), lower abdominal pain or vaginal discharge with fever (16%), and menstrual bleeding disorders or pain (15%). Under more extensive probing by a gynecologist, the proportion of women reporting menstrual problems rose to 62%. At medical examination, 36% of women had at least one clinically diagnosed reproductive tract infection, including pelvic inflammatory disease (11%), cervical ectopy (10%), and genital prolapse (3%). More than half had endogenous infections. The two most common infections, identified by laboratory tests, were bacterial vaginosis (18%) and mucopurulent cervicitis (37%). Sexually transmitted diseases, primarily trichomonal vaginalis, were diagnosed in 10%. Women residing in town, those with 6 or more years of schooling, and women with 4 or more pregnancies were significantly more likely to report menstrual problems. Laboratory-detected vaginosis was significantly higher among urban and sterilized women. There were no significant associations between demographic/socioeconomic status variables and the other reproductive health problems analyzed. Finally, severe anemia was present in 17% and chronic energy deficiency in 12%. The combination of widespread undernutrition/malnutrition and reproductive tract infections revealed in this study indicates an urgent need to take steps to implement the reproductive health strategy outlined at the 1994 Cairo Conference in South India.
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PMID:Levels and determinants of gynecological morbidity in a district of south India. 921 30

The nephrology nurses in collaboration with the nephrologist worked closely to avoid severe symptomatology related to calcium phosphorus imbalance. The surgical team support was discontinued 48 hours after the removal of the autotransplant. The patient exhibited classic signs of secondary hyperparathyroidism, as indicated by laboratory tests, anemia, and pruritus. Despite the level of anemia, the patient did not complain of fatigue or dyspnea. A hypocalcemic crisis was avoided by the ongoing assessment and intervention the patient received from the nursing staff. Four of the five stated goals were met. The patient is free of disability as evidenced by steady gait, normal range of motion, and adequate muscle strength. The calcium and phosphorus levels and the calcium phosphorus product are within acceptable ranges (see Figure 1). J.I. has always had information about diet and medication management but has demonstrated variable adherence to the regimen. However, the nephrology nurses plan to continue with counseling and education as needed.
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PMID:Patient, nurses, and physicians collaborating in the management of a patient following autotransplant parathyroidectomy. 932 98

Abnormal fatty acid metabolism may contribute to clinical problems such as itching, abnormal perspiration, susceptibility to infection, delayed wound healing, anemia, and increased hemolysis, as seen in patients with chronic renal failure. A double-blind study of patients on hemodialysis who received either fish oil, olive oil, or safflower oil documented that patients may have increased levels of the proinflammatory prostaglandin PGE2 and that fish oil intervention may decrease these levels, change the fatty acid profile, improve hematocrit levels, and improve patient perception of symptoms of pruritus.
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PMID:Essential fatty acid deficiency in renal failure: can supplements really help? 933 79

An 80-year-old woman being treated with anti-hypertensive drugs developed eruption and itching of the skin. High fever and lymph node enlargement subsequently developed in spite of discontinuing all antihypertensive drugs, and she was admitted to our hospital. At the initial examination, multiple papules were noted over the entire body, and the skin showed thickening and lichenification with scratch marks. There was also generalized enlargement of the superficial lymph nodes. From these findings, her condition was diagnosed as chronic prurigo due to drug allergy. Laboratory tests showed inflammatory findings, anemia and a high serum level of IgE. Analysis of the surface marker of peripheral lymphocytes revealed no abnormalities. Bacteriologic cultures of blood revealed methicillin-resistant Staphylococcus aureus (MRSA). Histologic examination of the lymph nodes revealed chronic reactive lymphadenitis with a follicular pattern. She was strongly suspected of having MRSA septicemia, and so combination chemotherapy with vancomycin, minocycline and cefoperazone/sulbactam was started. However, 1 month after initiation of chemotherapy, the low-grade fever, eruption and moderate inflammatory findings persisted, and culture of the eruptions revealed MRSA. The prurigo was therefore considered to be the source of the septicemia, and daily application of diflucortolone ointment containing 3% acetic acid was started. Thereafter, the clinical and laboratory findings showed a rapid improvement. MRSA infections usually occur in compromised patients who are receiving antibiotics during prolonged hospitalization. The present case, who did not have any underlying disease, indicates that old-age is also an important factor for the development of MRSA septicemia.
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PMID:[Septicemia due to methicillin-resistant Staphylococcus aureus from chronic prurigo in an elderly woman]. 939 25

Since the obtained results from the pilot study indicated that dilazep which was a membrane stabilizer would be benefit to treatment and prevention of anemia and chronic leg ulcer in beta-thalassemia/hemoglobin E (beta-thal/HbE) patients, the authors had continued the study in a second phase, ie a double blind placebo control trial. Twenty-seven beta-thal/HbE patients were recruited in the study. Eight patients who suffered from chronic leg ulcer were given dilazep. The rest of patients were given dilazep or placebo according to a randomized table. Hence, 16 patients received dilazep and 11 received placebo. When we compared the number of unit of blood transfusion, hemoglobin level, 2-3 DPG and P50 value between the dilazep and placebo groups using unpaired t-test, we found that there were no statistical differences in any of the parameters. However, when we compared the data within the group using paired t-test, there was statistical decrease in blood requirement after treatment in the dilazep group (p < 0.05). Concerning with the treatment of chronic leg ulcer, 3 in 8 patients were completely healed within 3 months, 4 in 8 patients were improved and 1 in 8 patients was not improved. There were complaints of skin itching and mild epigastric pain in placebo group but the liver function tests, kidney function tests and cardiac enzyme did not significantly change during the medication.
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PMID:A double-blind placebo control trial of dilazep in beta-thalassemia/hemoglobin E patients. 964 Jun 22

Ballantyne syndrome is a condition in which the gravid patient essentially "mirrors" the in utero state of the hydropic fetus. The exact pathophysiological mechanism, however, is unclear. At 25 weeks gestation, a 28-year-old G3P2 presented with acute onset lower extremity edema, hyperuricemia, polyhydramnios, generalized pruritus, hemodilutional anemia, and pre-term labor. The human chorionic gonadotrophin (hCG) level was markedly elevated, at 570,020 mIU/ml. Postpartum, she developed a pre-eclampsia-like syndrome with oliguria and pulmonary effusions. Associated placental findings included a 8 x 7 x 7 cm chorangioma. Underlying placental ischemia, reflected by a hyperproliferative trophoblast, increased hCG secretion, and increased placental resistance may account for the maternal findings of Ballantyne syndrome.
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PMID:Ballantyne syndrome: is placental ischemia the etiology? 977 90

Seventeen cases of dapsone syndrome were seen in five years from 1992 onwards. Their mean age was 27.8 years (range 11 to 60 years). Male to female ratio was 1.1:1. Of these cases, seven had confirmed leprosy, nine were cases of suspected leprosy and one case had lichen planus. On an average, they developed the symptoms 27 days after the intake of dapsone. The cutaneous lesions were in the form of erythematous papules and plaques (13 cases), eczematous lesions (four cases) and associated bullous lesions (two cases). The other manifestations were: fever (16 cases), pruritus (15 cases), lymphadenopathy (14 cases), hepatomegaly (10 cases), icterus and oral erosions (five cases each), photosensitivity (four cases) and splenomegaly (two cases). Previous drug allergy was present in four cases. Elevated ESR and liver enzyme levels were invariable findings. Raised bilirubin levels and hemolytic anaemia were seen in eight cases. Apart from one case with hepatic encephalopathy, all other cases had a favourable outcome either on conservative management (eight cases) or on oral corticosteroids (eight cases). Oral provocation test was done in two cases with positive response while intradermal test was not very reliable.
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PMID:Dapsone syndrome--a five year retrospective analysis. 980 99

Cryoglobulins are a group of proteins with the common property of precipitating from cooled serum. Cooled cryoglobulinemia is a classic disease caused by immune complexes which subside on vessel walls and produce a clinical picture represented by recurrent purpura, asthenia, arthralgias, Raynaud's phenomenon, glomerulonephritis and sensorimotor neuropathy. The authors describe a case of a patient C.M., 37 years old, with cryoglobulinemia, chronic hepatitis C and gravidic cholestasis at 28 weeks' gestation. The clinical picture worsened with the appearance of mild hypertension with proteinuria and hypochromic anaemia. At 31 weeks' the arthralgic symptomatology and pruritus revealed degeneration with an alteration of glycemic profile values and treatment with rapid human insuline was started. The cardiotocography began to be pathologic and a cesarean section was performed; the newborn weighted 1570 g. Cooled cryoglobulinemia is a pathology which worsens in a gravidic state and can impair the outcome of pregnancy.
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PMID:Essential mixed type II cryoglobulinemia in a HCV positive pregnant woman: case report. 998 69


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